Thorn in the flesh: Pantoea agglomerans as a rare cause of pyogenic flexor tenosynovitis

Pyogenic flexor tenosynovitis (FTS) is a deep infection of the hand which typically presents after trauma such as penetrating injury, or laceration to the volar surface of the hand. Although skin flora such as Staphylococcus aureus are responsible for the vast majority of cases, more uncommon presentations with gram negative rods are also reported. Pantoea agglomerans is a rare gram-negative bacteria which has never been described as an etiology for FTS in the past. This study provides the case of a 29-year-old male who presented to our emergency department with FTS caused by P. agglomerans, as well as a review of relevant literature surrounding the management of Pantoea infections. This case report summarizes possible antibiotic management which was effective in other orthopedic and non-orthopedic patients, as well as highlighting clinical features of Pantoea subspecies. This report highlights the importance of considering environmental agents such as Pantoea spp. as etiological agents of infection with trauma sustained from plant material.